About Chronic Cough

What is Chronic Cough?

Chronic Cough is generally a cough that lasts 8 weeks or longer.  Persistent Cough, Constant Cough, Dry Cough, and Nagging Cough are other terms often used to describe this type of cough.  Chronic Cough can be an indication of a serious underlying medical problem.  Often, Chronic Cough is THE problem!

Persistent, nagging cough should not be ignored.  People who constantly cough should not learn to live with it.  Each cough is unique.  A comprehensive cough evaluation by an expert Cough Doctor will identify the precise cause and trigger of your cough and result in effective Chronic Cough treatment and sustainable relief.  Chronic Cough often has more than one cause and more than one trigger.  In fact, some cough patients have so many triggers that set-off a constant cough cycle that they consider themselves “Trigger Happy.”

Chronic Cough has debilitating physical and mental health consequences that adversely affect relationships, professional performance, and participation in social and recreational activities.  In short, Chronic Cough is disruptive and gets in the way of the quality of daily life.

People with Chronic Cough describe feeling afraid that something really serious could be the cause.  Some report feeling embarrassed, depressed, anxious, or frustrated about their cough.  Depressed because they are socially isolated; Embarrassed because all eyes are on them while their cough interrupts quiet zones.  Anxious because their colleagues avoid working with them for fear that they are sick and contagious.  And, frustrated because in spite of consulting many doctors and trying different cough remedies, they are still coughing.  Fatigue and Urinary Incontinence are other common consequences.

Why Do Some People Cough And Others Do Not?

Anatomy of a cough

Image source: health.harvard.edu

Cough is good!  But too much of anything is no good.  The goal of cough treatment is to normalize your cough, not get rid of it completely.  Primitive or basic cough prevents us from choking on food and other foreign objects.  Chronic Cough, however, has NO useful function; it’s only purpose is to irritate.

People with Chronic Cough can be “hard wired to cough.” In medical lingo, this is also known as a hypersensitive cough reflex or neurogenic cough.  This simply means that the nerve endings at the back of the throat are overly sensitive.  When these nerve endings are ignited by triggers such as allergies, post nasal drip, upper respiratory infections and other irritants, then the already sensitive nerve endings are set-on fire and result in cough.  Cough begets Cough, so the more you cough, the more you will cough.

The scientific finding of hypersensitive cough reflex is recent.  Knowing that some people are “hard wired to cough” helps us to understand why only some people have a constant cough when others are exposed to the very same irritants and do not cough.

Common Chronic Cough Symptoms

You may have chronic cough if your life is being disrupted by any of these symptoms:

Cough while talking

Throat clearing

Sore throat


Post-nasal drip

Tickle in the back of your throat

Cough with exercise

Cough with or after meals

Cough triggered by alcohol, chocolate, breath mints, fatty foods, or caffeine

Night-time cough

What are the steps leading-up to a cough?

  • Urge to cough.  People with Chronic Cough report feeling like there’s something stuck in the back of the throat.
  • Cough receptors in the upper airway (nose), larynx (voice box), lung, and esophagus are activated by direct irritation such as throat infection, post nasal drip or gastric acid (which has contact with the receptors in the larynx/voice box)
  • The receptors send a signal to the cough center in the lower brain area
  • The cough center then decides if there is enough stimulus to set off a cough
  • The cough center becomes hyperactive by repeated stimulation from the peripheral cough receptors
  • The cough center is also influenced by higher brain function which can result in a voluntary and habit cough
  • Stimulation of the upper airway, esophagus, and lung can heighten or sensitize the cough reflex without actually triggering off a cough. For example, acid or even food entering the esophagus from the stomach can send signals to the cough center to become more sensitive or irritable. Allergic nasal symptoms also send signals to the cough center and increase sensitivity.

Which medical conditions cause and trigger cough? 

  • Being hard-wired to cough, also known as hypersensitive cough reflex.  This means nerve endings at the back of the throat become irritated by triggers such as upper respiratory infection and nasal allergies and set-off constant cough.
  • Upper respiratory viral infections (like the common cold)
  • Post nasal drip
  • Sinusitis
  • Acid reflux or GERD
  • Asthma
  • Non-asthmatic inflammation
  • Blood pressure medication

Diagnosing Chronic Cough

There are different types of cough resulting from different medical conditions.  Cough treatment and relief relies on accurately determining the type and underlying reason of  your cough.  For example, cough can be associated with bronchitis. However, bronchitis symptoms with cough and a bronchitis diagnosis are vastly different from Chronic Cough diagnosis and treatment.  Diagnosis includes identifying the different aspects of cough reflex hypersensitivity AND  identifying anatomic causes  which can include upper airway/post nasal drip,  acid and non-acid reflux and cough asthma/lung inflammation.

In almost all cases, diagnosis, your individual cough profile, and your personalized treatment plan targeted at your unique cough will be completed during the initial evaluation at Center for Cough.

The initial evaluation includes a thorough medical history and physical exam exploring your cough symptoms and their consequences. Previous physician visits, laboratory testing, X-rays, and diagnostic procedures will be reviewed. Then, further testing may be performed during this visit using advanced diagnostic tools.  The tools may include:

  • Rhinolaryngoscopy
  • Pulmonary function studies
  • Pulmonary inflammatory testing
  • Allergy testing
  • Oropharyngeal pH (acid) probe

Schedule an Appointment

If you have symptoms of chronic cough, schedule an appointment with the Cough Doctor today.